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Betson J, Fein EC, Long D, Horrocks P. Too stressed to think? A scoping review of the literature for healthcare educators utilising high acuity clinical scenarios. BMC MEDICAL EDUCATION 2024; 24:990. [PMID: 39261880 PMCID: PMC11391698 DOI: 10.1186/s12909-024-05949-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 08/23/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND The practise of paramedicine can be highly stressful particularly where urgent lifesaving decisions need to be made. Traditionally, educators have adopted the approach of placing students in simulated stressful situations as a way of learning to cope with these challenges. It is unclear from the literature whether traditional stress inoculation enhances or hinders learning. This scoping review aims to identify and examine both the peer-reviewed and grey literature reporting physiological stress responses to high-acuity scenarios in paramedicine and cognate healthcare disciplines. METHODS Adhering strictly to JBI Evidence Synthesis Manual for conducting a scoping review, medical subject headings and areas, keywords and all other possible index terms were searched across EBSCOhost (Medline, CINAHL and APA PsycInfo), Scopus and, PubMed. English language articles both published (peer-reviewed academic papers, reports and conference proceedings) and unpublished (grey literature, Google Scholar reports) were included, and publications citing retrieved articles were also checked. RESULTS Searches performed across five electronic databases identified 52 articles where abstracts indicated potential inclusion. From this, 22 articles which reported physiological or psychophysiological responses to stressful scenario-based education were included. CONCLUSION This review identified that an acceptable level of stress during simulation can be beneficial, however a point can be exceeded where stress becomes a hinderance to learning resulting in underperformance. By identifying strategies to moderate the impact of acute stress, educators of paramedic and other healthcare students can utilise high-acuity clinical scenarios to their andragogical armamentarium which has the potential to improve real-world clinical outcomes.
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Affiliation(s)
- Jason Betson
- Faculty of Health, Australian Catholic University, Building 403, Daniel Mannix Building, 8 - 14 Brunswick St, Fitzroy, VIC, 3065, Australia.
- School of Health and Medical Sciences, Centre for Health Research, University of Southern Queensland, Ipswich, Australia.
| | - Erich C Fein
- School of Psychology and Wellbeing, Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - David Long
- School of Health and Medical Sciences, Centre for Health Research, University of Southern Queensland, Ipswich, Australia
| | - Peter Horrocks
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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Vage A, Spence AD, Gormley GJ, McKeown G, Murphy P, Hamilton PK. Untapped resource: the simulation-based healthcare environment as a means to study human stress. THE ULSTER MEDICAL JOURNAL 2024; 92:157-166. [PMID: 38292502 PMCID: PMC10824135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
The effects of 'stress' within the healthcare professions are wide-reaching, not least of all within the field of simulation-based healthcare education. Whilst this popular method of experiential learning offers a 'safe space' for participants to develop their skillset, it also has a more surreptitious action; namely, the incubation of simulation-related stress. Currently, research concerning the complex relationship between stress, learning, and performance is ambiguous, leaving fertile ground for simulationists to debate what level of stress is appropriate for an optimised educational experience. In this narrative review, we examine the human response to stress and outline the various methods that have been used by researchers to measure stress in a quantifiable and standardised way. We then provide a brief overview of simulation-based healthcare education before describing why stress responses have been of interest to healthcare educationalists for some time. Finally, we outline how simulation education environments might provide an ideal environment for studying the human response to stress generally, with ramifications extending beyond the field of medical education.
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Affiliation(s)
- Aaron Vage
- Centre for Medical Education, Queen’s University Belfast, Whitla Medical Building, Lisburn Road, Belfast, BT9 7BL
| | - Andrew D Spence
- Centre for Medical Education, Queen’s University Belfast, Whitla Medical Building, Lisburn Road, Belfast, BT9 7BL
| | - Gerard J Gormley
- Centre for Medical Education, Queen’s University Belfast, Whitla Medical Building, Lisburn Road, Belfast, BT9 7BL
| | - Gary McKeown
- School of Psychology, Queen’s University Belfast, David Keir Building, Malone Road, Belfast, BT9 5BN
| | - Paul Murphy
- School of Arts, English and Languages, Queen’s University Belfast, University Square, Belfast, BT7 1NN
| | - Paul K Hamilton
- Centre for Medical Education, Queen’s University Belfast, Whitla Medical Building, Lisburn Road, Belfast, BT9 7BL
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Andersson U, Boysen GN, Sterner A. Simulation-based education as a provider of fieldwork insights - experiences of ambulance nurse specialist students. BMC Nurs 2023; 22:485. [PMID: 38115025 PMCID: PMC10729564 DOI: 10.1186/s12912-023-01666-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Medicine is facing a global shortage of nurses, including those with postgraduate education. One suggested educational method for undergraduate and postgraduate education, such as specialist ambulance nurse education, is simulation-based education (SBE). The implementation of SBE is motivated, in part, by the desire to attract and retain students, but also to contribute to student learning. Consequently, the use of SBE is increasing in specialist ambulance nurse education. The aim of this study was to explore how specialist ambulance nursing students experience SBE. METHODS This qualitative survey study involved the collection of study data using a purposefully designed, paper-based survey comprising five open-ended questions that required participant free-text answers. The answers were analysed using inductive content analysis and searching for descriptions of the participants' experiences. The survey was presented to 35 specialist ambulance nursing students. RESULTS The results are presented in two themes: SBE as learning and SBE as an educational method. Participating in SBE during the programme provides students with a realistic understanding of their future profession and its expected demands. The learning experience disregards prior work experience in ambulance services. CONCLUSIONS Based on the findings, conclusions are that SBE is an appreciated educational method among nursing students, regardless of their prior experience in the field of prehospital care. To some extent, this differs from previous research findings related to this subject. Furthermore, SBE contributes to the provision of field work insights, preparing the ambulance nurse specialist students.
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Affiliation(s)
- Ulf Andersson
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden.
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, 501 90, Sweden.
| | - Gabriella Norberg Boysen
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, 501 90, Sweden
| | - Anders Sterner
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, SE-501 90, Sweden
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, 501 90, Sweden
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Deluche E, Salle H, Leobon S, Facchini-Joguet T, Fourcade L, Taibi A. ACACIAS 1: The physiological and subjective impacts of high fidelity simulation of the breaking of bad news. J Visc Surg 2023; 160:323-329. [PMID: 37005112 DOI: 10.1016/j.jviscsurg.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
STUDY OBJECTIVE Breaking bad news (BN) is difficult and necessitates targeted training. To be effective, training may call for High Fidelity Simulation (HFS). This prospective study was conducted to objectively assess the impact of HFS as a tool conducive to the development of clinical competence in situations involving the delivery of bad news. METHODS This feasibility study was conducted from January to May 2021 and included students in medical oncology and digestive surgery. The subjective and objective impacts of HFS were evaluated by means of a self-administered questionnaire and a wristband, Affect-tag, which recorded several indicators: emotional power (EP), emotional density (DE) and cognitive load (CL) in students undergoing training. RESULTS Forty-six (46) students with a median age of 25 years (21-34 years) were included. While the participants were effectively and emotionally involved in the HFS training, they were not completely overwhelmed by their emotions, a possible occurrence in this type of program. After two training programs, the students presented with lower EP (P<0.001) and higher DE (P=0.005), while their CL remained stable (P=0.751). The information given in the self-administered questionnaires and the evaluations by outside professionals (actor, nurse, psychologist…) highlighted improved skills. CONCLUSION Taking into account the emotional parameters observed and the questionnaires collected, HFS can be considered as a suitable and effective tool in the breaking of bad news.
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Affiliation(s)
- E Deluche
- Department of Medical Oncology, Limoges University Hospital, Limoges, France; Digital Health Education Department, Faculty of Medicine, University of Limoges, Limoges, France.
| | - H Salle
- Department of Neurosurgery, Limoges University Hospital, Limoges, France
| | - S Leobon
- Department of Medical Oncology, Limoges University Hospital, Limoges, France
| | | | - L Fourcade
- Digital Health Education Department, Faculty of Medicine, University of Limoges, Limoges, France; Department of Pediatric Visceral Surgery, Limoges University Hospital, Children's Hospital, Limoges, France
| | - A Taibi
- Department of Digestive, General and Endocrinology Surgery, Limoges University Hospital, Limoges, France
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Nakayama N, Ejiri H, Arakawa N, Makino T. Role of peer learning and self-efficacy in parasympathetic activity during the simulation learning process in nursing students. Nurs Open 2023; 10:552-559. [PMID: 36631730 PMCID: PMC9834192 DOI: 10.1002/nop2.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/09/2022] [Accepted: 07/29/2022] [Indexed: 01/16/2023] Open
Abstract
AIMS This study aimed to investigate the stress level, including parasympathetic nervous activity, of students engaged in peer learning during simulations and the role of self-efficacy. DESIGN Observational-comparative study. METHODS The participants were 76 nursing students who were asked to evaluate a stable postoperative patient in Scene 1 and the same patient bleeding in Scene 2. In each scene, the students engaged in phases of repeated individual observations of the patient and discussions with peers. We compared each participant's parasympathetic activity during each observation in Scenes 1 and 2. Furthermore, the self-efficacy score before the simulation was used to divide the participants into 3 groups, and the self-efficacy and parasympathetic activity during the simulation were analysed. RESULTS The participants' parasympathetic activity decreased in both scenes with each phase of repeated observation. Two-way repeated-measures analysis of variance showed no statistically significant difference in parasympathetic activity during simulations among the three self-efficacy groups.
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Affiliation(s)
- Natsuki Nakayama
- Department of Integrated Health Sciences, Graduate School of MedicineNagoya UniversityNagoyaJapan
| | - Harumi Ejiri
- Department of Nursing, College of Life and Health SciencesChubu UniversityKasugaiJapan
| | - Naoko Arakawa
- Department of Nursing, College of Life and Health SciencesChubu UniversityKasugaiJapan
| | - Tsuneko Makino
- Department of Nursing, College of Life and Health SciencesChubu UniversityKasugaiJapan
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Muacevic A, Adler JR. A Systematic Review of Heart Rate Variability as a Measure of Stress in Medical Professionals. Cureus 2023; 15:e34345. [PMID: 36865953 PMCID: PMC9974008 DOI: 10.7759/cureus.34345] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 03/04/2023] Open
Abstract
Understanding the physiological effects of responding to crises is a critical component in understanding how to manage and prepare medical professionals to be crisis responders. Heart rate variability (HRV) is the variation in rate between a succession of R-R intervals. This variation is not only affected by physiological processes such as respiration or metabolic rate but is also directly controlled by the autonomic nervous system. As such, heart rate variability has been proposed as a noninvasive tool to measure the physiological stress response. The aim of this systematic review is to consolidate heart rate variability literature in the context of medical emergencies to determine if heart rate variability changes predictably from baseline when responding to medical crises. This may demonstrate utility as an objective, noninvasive measure of stress response. A systematic literature review of six databases yielded 413 articles, 17 of which met our inclusion criteria of being written in English, measuring HRV in healthcare providers, and measuring HRV in real or simulated medical resuscitations or procedures. Articles were then analyzed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) scoring system. Out of the 17 articles reviewed, 11 demonstrated statistically significant results showing heart rate variability responding in a predictable manner to stress. Three articles utilized a medical simulation as the stressor, six used medical procedures, and eight used medical emergencies encountered during clinical work. Overall, a predictable trend in heart rate variability metrics of standard deviation from the mean value of normal-to-normal (N-N) intervals (SDNN), root mean square of the successive differences (RMSSD), mean number of times per time interval in which the change in successive normal sinus (N-N) intervals exceeds 50 ms (PNN50), low frequency % (LF%), and low-frequency-to-high-frequency ratio (LF/HF) was observed when responding to stress. This systematic literature review showed that heart rate variability among healthcare providers responding to stressful scenarios follows a predictable pattern of change and expands our understanding of the physiology of stress in healthcare providers. This review supports the use of HRV to monitor stress during high-fidelity simulation to ensure that appropriate physiological arousal is achieved during the training of medical personnel.
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Espejo-Antúnez L, Fernández-Morales C, Hernández-Sánchez S, Cardero-Durán MDLÁ, Toledo-Marhuenda JV, Albornoz-Cabello M. The Impact on the Stress-Associated Autonomic Response of Physiotherapy Students Receiving Interferential Current in an Electrotherapy Training Session. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13348. [PMID: 36293928 PMCID: PMC9603673 DOI: 10.3390/ijerph192013348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Electrical currents are didactic contents widely applied in the training of physiotherapy students, but the treatment is considered a stressful situation for both the patient who receives it and the student who applies it. The aim of this study was to evaluate the stress-associated autonomic response of physiotherapy students receiving interferential current by measuring and analysing heart rate variability. An observational case-control study was conducted. Ninety healthy male volunteers, all physiotherapy degree students, were enrolled while attending laboratory practice during the 2020-2021 academic year. Participants were randomly allocated to a sham electrotherapy group (44 subjects), in which heart rate variability was recorded for 10 min, both at rest and during the application of sham technique on the lower back (10 min), and an electrotherapy group (46 subjects), applying the same procedure with the electrical current flowing. Outcome measures included baseline (seated position) and postintervention (prone position) time domain parameter, diameters of the Poincaré plot 1 and 2, stress score, and sympathetic/parasympathetic ratio. The sham electrotherapy group exhibited significant increases in time domain parameter (p = 0.027) and diameters of the Poincaré plot 1 (p = 0.032), with a small effect size (d ≤ 0.5). The electrotherapy group exhibited significant increases in time domain parameter and diameters of the Poincaré plot 1 and 2 (p < 0.001) and decreases in the stress score and sympathetic/parasympathetic ratio (p < 0.001), with a large effect size (d > 0.8) other than for the time domain parameter (d = 0.42), indicating increased parasympathetic and decreased sympathetic activity. After interventions, there were significant differences between groups in diameters of the Poincaré plot 2 (p < 0.001), stress score (p = 0.01) and sympathetic/parasympathetic ratio (p = 0.003), with moderate effect size (d > 0.5). The application of the interferential current technique produces stress-associated autonomic response characterized by greater parasympathetic activity and decreased sympathetic activity. Further studies are needed to determine possible adverse effects.
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Affiliation(s)
- Luis Espejo-Antúnez
- Department of Medical-Surgical Therapeutics, Faculty of Medicine and Health Sciences, University of Extremadura, 06006 Badajoz, Spain
| | - Carlos Fernández-Morales
- Department of Medical-Surgical Therapeutics, Faculty of Medicine and Health Sciences, University of Extremadura, 06006 Badajoz, Spain
| | - Sergio Hernández-Sánchez
- Department of Pathology and Surgery (Area of Physiotherapy), Faculty of Medicine, Miguel Hernández University, 03550 Alicante, Spain
| | | | - José Vicente Toledo-Marhuenda
- Department of Pathology and Surgery (Area of Physiotherapy), Faculty of Medicine, Miguel Hernández University, 03550 Alicante, Spain
| | - Manuel Albornoz-Cabello
- Department of Physical Therapy, Faculty of Nursing, Physical Therapy and Podiatry, University of Seville, 41009 Seville, Spain
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Kaklauskas A, Abraham A, Ubarte I, Kliukas R, Luksaite V, Binkyte-Veliene A, Vetloviene I, Kaklauskiene L. A Review of AI Cloud and Edge Sensors, Methods, and Applications for the Recognition of Emotional, Affective and Physiological States. SENSORS (BASEL, SWITZERLAND) 2022; 22:7824. [PMID: 36298176 PMCID: PMC9611164 DOI: 10.3390/s22207824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/28/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Affective, emotional, and physiological states (AFFECT) detection and recognition by capturing human signals is a fast-growing area, which has been applied across numerous domains. The research aim is to review publications on how techniques that use brain and biometric sensors can be used for AFFECT recognition, consolidate the findings, provide a rationale for the current methods, compare the effectiveness of existing methods, and quantify how likely they are to address the issues/challenges in the field. In efforts to achieve the key goals of Society 5.0, Industry 5.0, and human-centered design better, the recognition of emotional, affective, and physiological states is progressively becoming an important matter and offers tremendous growth of knowledge and progress in these and other related fields. In this research, a review of AFFECT recognition brain and biometric sensors, methods, and applications was performed, based on Plutchik's wheel of emotions. Due to the immense variety of existing sensors and sensing systems, this study aimed to provide an analysis of the available sensors that can be used to define human AFFECT, and to classify them based on the type of sensing area and their efficiency in real implementations. Based on statistical and multiple criteria analysis across 169 nations, our outcomes introduce a connection between a nation's success, its number of Web of Science articles published, and its frequency of citation on AFFECT recognition. The principal conclusions present how this research contributes to the big picture in the field under analysis and explore forthcoming study trends.
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Affiliation(s)
- Arturas Kaklauskas
- Department of Construction Management and Real Estate, Vilnius Gediminas Technical University, Sauletekio Ave. 11, LT-10223 Vilnius, Lithuania
| | - Ajith Abraham
- Machine Intelligence Research Labs, Scientific Network for Innovation and Research Excellence, Auburn, WA 98071, USA
| | - Ieva Ubarte
- Institute of Sustainable Construction, Vilnius Gediminas Technical University, Sauletekio Ave. 11, LT-10223 Vilnius, Lithuania
| | - Romualdas Kliukas
- Department of Applied Mechanics, Vilnius Gediminas Technical University, Sauletekio Ave. 11, LT-10223 Vilnius, Lithuania
| | - Vaida Luksaite
- Department of Construction Management and Real Estate, Vilnius Gediminas Technical University, Sauletekio Ave. 11, LT-10223 Vilnius, Lithuania
| | - Arune Binkyte-Veliene
- Institute of Sustainable Construction, Vilnius Gediminas Technical University, Sauletekio Ave. 11, LT-10223 Vilnius, Lithuania
| | - Ingrida Vetloviene
- Department of Construction Management and Real Estate, Vilnius Gediminas Technical University, Sauletekio Ave. 11, LT-10223 Vilnius, Lithuania
| | - Loreta Kaklauskiene
- Department of Construction Management and Real Estate, Vilnius Gediminas Technical University, Sauletekio Ave. 11, LT-10223 Vilnius, Lithuania
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Hansen MT, Olsen RM, Brynhildsen S, Leonardsen A. Nursing students' perceived stress, self-efficacy, control and evaluation of a course in systematic clinical observation, physical assessment and decision-making: An observational study in Norway. Nurs Open 2022; 10:1007-1015. [PMID: 36126110 PMCID: PMC9834509 DOI: 10.1002/nop2.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/14/2021] [Accepted: 08/30/2022] [Indexed: 01/16/2023] Open
Abstract
AIM Simulation-based nursing education interventions have a strong educational effect on psychomotoric skills, but students may experience physiological stress and anxiety during simulation. The aims of this study were to explore (1) nursing students' perceived stress, self-efficacy, control and evaluation before and after simulation as part a structured course in physical assessment, (2) whether factors such as gender, age or previous work experience were associated with perceived stress during simulation and (3) nursing students evaluation of the course. DESIGN An observational, cross-sectional study before and after simulation and a course in physical assessment. METHODS We utilized "the Self-Assessment Manikin for measuring emotion" before and after simulation, a questionnaire to identify symptoms of stress after simulation, and a questionnaire to evaluate the physical assessment course. RESULTS A total of 59 students participated. Students perceived stress before simulation but reported a lower degree of activation, a more positive mood, increased feeling of control and self-efficacy after the simulation. They also felt more secure about their assessments. Even though students reported of several symptoms of stress before simluation, the course increased students' self-reported competence and feeling of security.
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Affiliation(s)
| | | | - Siri Brynhildsen
- Department of Health and WelfareØstfold University CollegeHaldenNorway
| | - Ann‐Chatrin Linqvist Leonardsen
- Department of Health and WelfareØstfold University CollegeHaldenNorway,Department of AnesthesiaØstfold Hospital TrustGrålumNorway
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Ruiz TL, Sellers B, Devarakonda A, Wehrle CJ, Arora TK. A Novel Mock Oral Curriculum for Senior Surgery Residents: Results of a Pilot Study. J Surg Res 2022; 277:92-99. [DOI: 10.1016/j.jss.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/20/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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López-Jiménez JJ, Fernández-Alemán JL, González LL, Sequeros OG, Valle BM, García-Berná JA, Idri A, Toval A. Taking the pulse of a classroom with a gamified audience response system. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 213:106459. [PMID: 34768233 DOI: 10.1016/j.cmpb.2021.106459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVE This paper presents an empirical study of a gamified mobile-based assessment approach that can be used to engage students and improve their educational performance. METHOD A gamified audience response system called G-SIDRA was employed. Three gamification elements were used to motivate students in classroom activities: badges for achievements to increase engagement, points to indicate progression and performance in the subject and ranking for promoting competitiveness. A total of 90 medical students in a General and Descriptive Anatomy of the Locomotor System course were taught using G-SIDRA in the academic year 2019/2020. Smart bracelets were configured to collect heart rate measurements from 30 students with the aim of evaluating the impact of the gamification elements. The control group consisted of a sample of 110 students enrolled on the same course in the academic year 2016/2017 using non-gamified SIDRA. RESULTS Statistically significant differences were found between multiple choice questions (MCQ) scores obtained by using SIDRA and G-SIDRA in the four experiments (U = 1.621,50, p < 0,01 for Exp1; U = 1.950,00, p < 0,01 for Exp2; U = 955,00, p < 0,01 for Exp3; U = 2.335,00, p < 0,01 for Exp4). In the students' final exam grades, statistically significant differences between students that used G-SIDRA as opposed to SIDRA (T(157) = 3.992; p = 0.044) were obtained. Concerning gamification elements, statistically significantly differences were found in comparing the pulse increases after and before the badge event in the four experiments (U = 2.484,00, p = 0,038 for Exp1; U = 2.109,50, p = 0,046 for Exp2; U = 1.790,50, p = 0,025 for Exp3; U = 1.557,0, p = 0,048 for Exp4). However, there are not statistically significant differences between the pulse increases after and before the ranking event in the four experiments. In a 5-point Likert-type scale, the students expressed satisfaction with G-SIDRA (M = 4.552) and thought the system helped to better understand both theoretical and practical concepts (M = 4.092). Their global assessment of the G-SIDRA platform was 4.471. CONCLUSIONS Of the three gamification elements used in the study, only badge has an effect on heart rate. Better student responses and academic performance were achieved when using G-SIDRA. Nevertheless, more research is required to evaluate the impact of the gamification elements on the motivation, engagement and performance of students. Physiological measures are promising approaches for gamification elements evaluation.
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Affiliation(s)
- Juan J López-Jiménez
- Faculty of Computer Science, Department of Informatics and System, University of Murcia, Campus of Espinardo, Murcia, Spain.
| | - José L Fernández-Alemán
- Faculty of Computer Science, Department of Informatics and System, University of Murcia, Campus of Espinardo, Murcia, Spain.
| | - Laura López González
- Faculty of Medicine, Department of Human Anatomy, Campus of Espinardo, University of Murcia, Spain.
| | - Ofelia González Sequeros
- Faculty of Medicine, Department of Human Anatomy, Campus of Espinardo, University of Murcia, Spain.
| | - Begoña Moros Valle
- Faculty of Computer Science, Department of Informatics and System, University of Murcia, Campus of Espinardo, Murcia, Spain.
| | - José A García-Berná
- Faculty of Computer Science, Department of Informatics and System, University of Murcia, Campus of Espinardo, Murcia, Spain.
| | - Ali Idri
- Software Project Management Research Team, ENSIAS, Mohammed V University in Rabat, Rabat, Morocco.
| | - Ambrosio Toval
- Faculty of Computer Science, Department of Informatics and System, University of Murcia, Campus of Espinardo, Murcia, Spain.
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Boyanov N, Georgiou K, Thanasas D, Deneva T, Oussi N, Marinov B, Enochsson L. Use of saliva stress biomarkers to estimate novice male endoscopist's stress during training in a high-end simulator. Scand J Gastroenterol 2021; 56:1380-1385. [PMID: 34424793 DOI: 10.1080/00365521.2021.1965208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Simulated endoscopic training can be challenging and stressful for the novice trainee. The absence of a reliable stress detection method during simulated endoscopic training makes estimating trainees' mental stress difficult to quantify. This study concomitantly measures the responses of four saliva stress biomarkers and compares them to the video score (VS) achieved by novice endoscopists in a reproducibly stressful simulation environment. METHODS Thirty-six male endoscopy naïve surgery residents were enrolled. After an orientation phase, a saliva specimen was collected for cortisol (sC), alpha-amylase (sAA), Chromogranin A (sCgA), and immunoglobulin A (sIgA) measurements (baseline phase, BL). Thereafter, the simulation exercise phase (E) started, practicing in the Fundamentals of Endoscopic Surgery Skills module (GI-Bronch Mentor). Immediately after, a second saliva sample for measuring the above-cited biomarkers was collected. The whole experiment was videotaped, and the VS was calculated. The percentage (E-BL)diff of each of the four saliva biomarkers was calculated and examined for correlation to VS. RESULTS sCgAdiff showed the best correlation with VS, followed by sAAdiff. CONCLUSIONS sCgA and sAA, are saliva stress biomarkers that are easy to collect non-invasively and showed the best correlation with novice endoscopist's performance in our simulation setting, and therefore, they could be used for monitoring stress.
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Affiliation(s)
- Nikola Boyanov
- Medical Simulation Training Center at Research Institute of Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Konstantinos Georgiou
- 1st Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Thanasas
- Medical Physics Laboratory Simulation Center, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Tanya Deneva
- Central Clinical Laboratory, University Hospital St. George, Plovdiv, Bulgaria.,Department of Clinical Laboratory, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Ninos Oussi
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Blagoi Marinov
- Medical Simulation Training Center at Research Institute of Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Dunham CM, Burger AJ, Hileman BM, Chance EA, Hutchinson AE. Bispectral Index Alterations and Associations With Autonomic Changes During Hypnosis in Trauma Center Researchers: Formative Evaluation Study. JMIR Form Res 2021; 5:e24044. [PMID: 34037529 PMCID: PMC8190650 DOI: 10.2196/24044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 02/10/2021] [Accepted: 04/13/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Previous work performed by our group demonstrated that intermittent reductions in bispectral index (BIS) values were found during neurofeedback following mindfulness instructions. Hypnosis was induced to enhance reductions in BIS values. OBJECTIVE This study aims to assess physiologic relaxation and explore its associations with BIS values using autonomic monitoring. METHODS Each session consisted of reading a 4-minute baseline neutral script and playing an 18-minute hypnosis tape to 3 researchers involved in the BIS neurofeedback study. In addition to BIS monitoring, autonomic monitoring was performed, and this included measures of electromyography (EMG), skin temperature, skin conductance, respiratory rate, expired carbon dioxide, and heart rate variability. The resulting data were analyzed using two-tailed t tests, correlation analyses, and multivariate linear regression analyses. RESULTS We found that hypnosis was associated with reductions in BIS (P<.001), EMG (P<.001), respiratory rate (P<.001), skin conductance (P=.006), and very low frequency power (P=.04); it was also associated with increases in expired carbon dioxide (P<.001), skin temperature (P=.04), high frequency power (P<.001), and successive heart interbeat interval difference (P=.04) values. Decreased BIS values were associated with reduced EMG measures (R=0.76; P<.001), respiratory rate (R=0.35; P=.004), skin conductance (R=0.57; P<.001), and low frequency power (R=0.32; P=.01) and with increased high frequency power (R=-0.53; P<.001), successive heart interbeat interval difference (R=-0.32; P=.009), and heart interbeat interval SD (R=-0.26; P=.04) values. CONCLUSIONS Hypnosis appeared to induce mental and physical relaxation, enhance parasympathetic neural activation, and attenuate sympathetic nervous system activity, changes that were associated with BIS values. Findings from this preliminary formative evaluation suggest that the current hypnosis model may be useful for assessing autonomic physiological associations with changes in BIS values, thus motivating us to proceed with a larger investigation in trauma center nurses and physicians.
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Affiliation(s)
| | - Amanda J Burger
- St Elizabeth Youngstown Hospital, Youngstown, OH, United States
| | | | - Elisha A Chance
- St Elizabeth Youngstown Hospital, Youngstown, OH, United States
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Yoshioka-Maeda K, Naruse K. Effectiveness of Health Guidance Simulation in Community Settings for Public Health Nursing Students: A Preliminary Study. SAGE Open Nurs 2021; 7:23779608211001355. [PMID: 33912671 PMCID: PMC8047855 DOI: 10.1177/23779608211001355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Simulation-based learning is a relatively new concept in public health nursing education, and little is known about the efficacy of this approach for teaching of health guidance. Objective: The aim of this study was to evaluate the effectiveness of health guidance simulation in community settings for public health nursing students. Methods Using a pre/post-test design, 29 public health nursing students in their third year participated in a high-fidelity simulation program with standardized patients. We developed six scenarios on health guidance for three themes (mother and child, tuberculosis, and adult occupational health) and practice guidelines for the standardized patients to act and assist in understanding of the purpose of the course. Data were collected at baseline and after the simulation sessions through evaluation sheets that the students placed in a designated box on campus. Changes in the level of self-confidence of the students were evaluated based on the “practical skills required for public health nurses and achievement level at graduation” of the Ministry of Health, Labor and Welfare, and the skills in the minimum requirements for public health nurse education defined by the Japan Association of Public Health Nurse Educational Institutions. Results The total score for self-confidence and the mean self-confidence scores for health guidance skills for mother and child, tuberculosis, and adult occupational health nursing were significantly higher post-test compared to pre-test (p < 0.001). Conclusion These results indicate that high-fidelity simulation focused on health guidance in community settings can bridge the gap between theoretical knowledge and practice of students.
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Affiliation(s)
- Kyoko Yoshioka-Maeda
- Department of Health Promotion, National Institute of Public Health, Saitama, Japan
- Kyoko Yoshioka-Maeda, Department of Health Promotion, National Institute of Public Health, 2-3-6, Minami, Wako-shi, Saitama 351-0197, Japan.
| | - Kazuko Naruse
- School of Nursing, Faculty of Medicine, Tokyo Medical University, Tokyo, Japan
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15
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Nakayama N, Ejiri H, Arakawa N, Makino T. Stress and anxiety in nursing students between individual and peer simulations. Nurs Open 2021; 8:776-783. [PMID: 33570282 PMCID: PMC7877161 DOI: 10.1002/nop2.680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/25/2020] [Accepted: 10/28/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The use of high-fidelity simulation practice as an educational tool is becoming increasingly prevalent in nursing education. Despite the learning effects of simulation practice, students have been shown to experience high levels of stress and anxiety during simulation. In recent years, peer learning has been defined as an acquisition of knowledge and skills through active support and support among equal or equal peers and has been shown to be an effective educational intervention for clinical health science students. AIM The purpose of this study was to incorporate peer learning into simulation learning and to clarify the differences between stress and anxiety during personal and peer simulations. METHOD Third-grade undergraduate students in a four-year course at two nursing universities participated in this study. In this study, the simulated patient was a 53-year-old man who had undergone gastrectomy for the treatment of gastric cancer. The scenario was that the patient had completely recovered consciousness in the operating room, and his tracheal tube had been removed one hour before the students examined him. Stress while simulation training was evaluated with heart rate variability. Anxiety was evaluated by the STAI after the simulations were complete. RESULTS Personal simulation practice (personal group; n = 50) and peer simulation practice (peer group, n = 59) was conducted. The personal group included 7 male students, and the peer group included 12 male students; the difference in male proportion was not significant. At the first patient assessment phase, stress of heart rate variability components at the peer group significantly increased relative to that of the personal. In addition, the personal had a significantly higher state anxiety score after simulation than the peer. CONCLUSION This study shows that in the face-to-face scene involving vital sign measurements, the presence of peers did not objectively alleviate stress.
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Affiliation(s)
- Natsuki Nakayama
- Department of Integrated Health SciencesGraduate School of MedicineNagoya UniversityNagoyaJapan
| | - Harumi Ejiri
- Department of NursingCollege of Life and Health SciencesChubu UniversityKasugaiJapan
| | - Naoko Arakawa
- Department of NursingCollege of Life and Health SciencesChubu UniversityKasugaiJapan
| | - Tsuneko Makino
- Department of NursingCollege of Life and Health SciencesChubu UniversityKasugaiJapan
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16
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Evaluating Impact of Repeated Exposure to High Fidelity Simulation: Skills Acquisition and Stress Levels in Postgraduate Critical Care Nursing Students. Clin Simul Nurs 2020. [DOI: 10.1016/j.ecns.2020.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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17
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Farrés-Tarafa M, Roldán-Merino J, Lorenzo-Seva U, Hurtado-Pardos B, Biurrun-Garrido A, Molina-Raya L, Morera-Pomarede MJ, Bande D, Raurell-Torredà M, Casas I. Reliability and validity study of the Spanish adaptation of the "Educational Practices Questionnaire" (EPQ). PLoS One 2020; 15:e0239014. [PMID: 32941464 PMCID: PMC7497994 DOI: 10.1371/journal.pone.0239014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/27/2020] [Indexed: 11/19/2022] Open
Abstract
The Educational Practices Questionnaire is an instrument for assessing students perceptions of best educational practices in simulation. As for other countries, in Spain, it is necessary to have validated rubrics to measure the effects of simulation. The objective of this study was to carry out a translation and cultural adaptation of the Educational Practices Questionnaire into Spanish and analyze its reliability and validity. The study was carried out in two phases: (1) adaptation of the questionnaire into Spanish. (2) Cross-sectional study in a sample of 626 nursing students. Psychometric properties were analyzed in terms of reliability and construct validity by confirmatory and exploratory factor analysis. The exploratory and confirmatory factor analyses showed that the one-dimensional model is acceptable for both scales (presence and importance). The results show that the participants' scores can be calculated and interpreted for the general factor and also for the four subscales. Cronbach's alpha and the Omega Index were also suitable for all the scales and for each of the dimensions. The Educational Practices Questionnaire is a simple and easy-to-administer tool to measure how nursing degree students perceive the presence and importance of best educational practices.
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Affiliation(s)
- Mariona Farrés-Tarafa
- Campus Docent, Sant Joan de Déu—Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
- Research Group GIES (Grupo de investigación en Enfermería, Educación y Sociedad), Barcelona, Spain
- Member Research Group GRISIMula (Grupo emergente 2017 SGR 531; Grupo en Recerca Enfermera en Simulación), Barcelona, Spain
- Secretaria Research Group GRISCA (Grupo en Recerca Enfermera en Simulación en Cataluña y Andorra), Barcelona, Spain
| | - Juan Roldán-Merino
- Campus Docent, Sant Joan de Déu—Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
- Research Group GIES (Grupo de investigación en Enfermería, Educación y Sociedad), Barcelona, Spain
- Research Group GEIMAC (Consolidated Group 2017–1681: Group of Studies of Invarianza of the Instruments of Measurement and Analysis of Change in the Social and Health Areas), Barcelona, Spain
- Coordinator Research Group GIRISAME (International Researchers Group of Mental Health Nursing Care), Barcelona, Spain
| | | | - Barbara Hurtado-Pardos
- Campus Docent, Sant Joan de Déu—Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
- Research Group GIES (Grupo de investigación en Enfermería, Educación y Sociedad), Barcelona, Spain
- Member Research Group GRIN (Grupo Consolidado de Recerca Infermeria, SRG:664), Barcelona, Spain
| | - Ainoa Biurrun-Garrido
- Campus Docent, Sant Joan de Déu—Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
- Research Group GIES (Grupo de investigación en Enfermería, Educación y Sociedad), Barcelona, Spain
| | - Lorena Molina-Raya
- Campus Docent, Sant Joan de Déu—Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
- Research Group GIES (Grupo de investigación en Enfermería, Educación y Sociedad), Barcelona, Spain
| | - Maria-Jose Morera-Pomarede
- Campus Docent, Sant Joan de Déu—Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
- Research Group GIES (Grupo de investigación en Enfermería, Educación y Sociedad), Barcelona, Spain
| | - David Bande
- Anesthesiologist, Servicio Anestesiología, Reanimación y Tratamiento del Dolor, Parc de Salut Mar, Barcelona, Spain
| | - Marta Raurell-Torredà
- Universidad de Barcelona, Barcelona, Spain
- Presidenta Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Madrid, Spain
- President Research Group GRISIMula (Grupo emergente 2017 SGR 531; Grupo en Recerca Enfermera en Simulación), Barcelona, Spain
| | - Irma Casas
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Preventive Medicine Service, Hospital Germans Trias i Pujol, Barcelona, Spain
- Research Group Innovation in Respiratory Infections and Tuberculosis Diagnosis (Group Consolidat 2017 SGR 494)
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Stein C. The effect of clinical simulation assessment on stress and anxiety measures in emergency care students. Afr J Emerg Med 2020; 10:35-39. [PMID: 32161710 PMCID: PMC7058871 DOI: 10.1016/j.afjem.2019.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/18/2019] [Accepted: 12/09/2019] [Indexed: 11/28/2022] Open
Abstract
Background Clinical simulation has become widespread as a training and assessment tool across a range of health professions, including emergency care. As with any form of assessment, simulations may be associated with stress and anxiety (“distress”) which may have a negative effect on student performance if demands required by the simulation outweigh the available resources. This study aimed to assess the effect of participation by students in an emergency care simulation on an objective measure of stress and a subjective measure of anxiety. Methods Heart rate variability (HRV) and scores from a validated state anxiety instrument (the State-Trait Anxiety Inventory) were assessed in 36 emergency medical care students participating in scheduled simulation assessments. Data recorded during a resting control period were used for comparison. Results HRV variables showed changes in the simulation assessment group suggesting decreased variability and parasympathetic withdrawal, however these were not significantly different to control. Heart rate in the simulation assessment group increased significantly (73.5/min vs. 107.3/min, p < 0.001). State anxiety scores increased significantly both before (33.5 vs. 49.1, p < 0.001) and after (33.5 vs. 60, p < 0.001) the simulation assessment, compared to control. No linear relationship was found between any HRV variables and anxiety scores. Conclusion Participating in an emergency care simulation assessment significantly elevated levels of anxiety in a group of 36 students, however an objective measure of stress did not identify changes significantly different to those at rest, with the exception of heart rate. The high levels of anxiety documented before and after simulation assessments may have a negative effect on performance and require further investigation.
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